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Referral details

Case 148605

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

#12,#13,#14 Non-healing PARL.

Referral reason

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1 Files Info

Canaray 148605

1. Rarefying osteitis at tooth 14: hypercementosis present

Rarefying osteitis is present around the apical half of the root of tooth 14. Hypercementosis is present on the mesial surface of the apical half of the root of the tooth. No signs of root fracture are present in tooth 14. In several recent cases, we at Canaray have noted that the presence of hypercementosis has inhibited periapical healing of endodontically treated teeth. It is possible that the tissue on the root surface in the region of the hypercementosis has been devitalized by the periapical lesion and serves as a local area of persistent pathology that will not respond to non-surgical treatment.

2. Secondarily affected tooth 15

The rarefying osteitis associated with tooth 14 extends distally to abut the mesial aspect of the apical third of the root of tooth 15. The remaining periapical and periradicular bone surrounding tooth 15 appears normal. This pattern of bone loss suggests that tooth 15 has been secondarily affected as opposed to a contributing source of inflammation.

3. Hypercementosis on tooth 13

Hypercementosis is visible around the root of tooth 13. The root surface of the tooth appears to have been secondarily affected by the endodontic lesion originating at tooth 14. However, the presence of hypercementosis on the root surface may be a contributory factor to the ongoing periradicular pathology in this region. Buccal abrasion is present at the level of the cementoenamel junction of tooth 13.

4. Secondarily affected tooth 12

Tooth 12 exhibits rarefying osteitis on its distopalatal surface which appears to be secondary to the larger lesion associated with the hypercementosis at teeth 13 and 14. No pathology is evident in the apical foramen of tooth 12, which suggests that this tooth is not the source of the lesion. No hypercementosis is radiographically evident at tooth 12.

5. Secondarily affected tooth 11

The lesion originating in the mid first quadrant extends to the distal surface of the apical third of the root of tooth 11. No pathology is present at the root apex of tooth 11. This suggests that tooth 11 has been secondarily affected by the lesion, and is not the source of any pathology.

6. Slightly thickened mucosal lining of the right maxillary sinus

The mucosal lining of the right maxillary sinus is slightly thickened. This is a non-significant incidental finding.